If you think there ought to be a law about access to specialists and specialty centers, there is! New York State health care consumers are protected by a new law which gives them important rights in a managed care environment.
If you are enrolled in a managed care organization, you have a Right to Specialty Care, including information about the following:
- Out of Network Referrals: If your MCO, consulting with your PCP, decides that an MCO network doesn't include a PCP in their network with the training and experience you need, the MCO must refer you to a specialist out of the network at no charge to you. This decision must be part of a treatment plan approved by the MCO.
- Standing Referral to Specialists: If the MCO, consulting with your PCP and your specialist, decides that you need ongoing care from that specialist, you can get a series of referrals at one time so you don't have to go back and get a new referral each time you need to see the specialist.
- Specialist Care Coordinator: If you need specialized medical care over a long period of time, you can, at no extra cost, get a referral to a specialist who will then act as your PCP and coordinate your care.
- Specialty Care Center: If you need specialized medical care over a long period of time, your MCO must allow a referral to a specialty care center (such as a cancer institute), which can provide and/or coordinate your primary and specialty care.
A specialty care center is any "Center accredited or designated by an agency of the State or Federal Government or by a voluntary National Health Organization as having special expertise in treating the condition or disease for which it has been a accredited." Roswell Park Cancer Institute is a National Cancer Institute-designated Comprehensive Cancer Center.
*Adapted from the Consumers' Guide to New York's Managed Care Bill of Rights, published by the Public Policy and Education Fund of New York.